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**Recent research has shown that inhibition of inflammatory mediators (such as nitric oxide & VIP) may lead to improved gastrointestinal peristalsis and function. | **Recent research has shown that inhibition of inflammatory mediators (such as nitric oxide & VIP) may lead to improved gastrointestinal peristalsis and function. | ||
* | *Another sever form of ileus is also known as Chronic intestinal pseudo-obstruction (CIPO).<ref name="Di NardoDi Lorenzo2017">{{cite journal|last1=Di Nardo|first1=G.|last2=Di Lorenzo|first2=C.|last3=Lauro|first3=A.|last4=Stanghellini|first4=V.|last5=Thapar|first5=N.|last6=Karunaratne|first6=T. B.|last7=Volta|first7=U.|last8=De Giorgio|first8=R.|title=Chronic intestinal pseudo-obstruction in children and adults: diagnosis and therapeutic options|journal=Neurogastroenterology & Motility|volume=29|issue=1|year=2017|pages=e12945|issn=13501925|doi=10.1111/nmo.12945}}</ref><ref name="pmid23831693">{{cite journal |vauthors=Iida H, Ohkubo H, Inamori M, Nakajima A, Sato H |title=Epidemiology and clinical experience of chronic intestinal pseudo-obstruction in Japan: a nationwide epidemiologic survey |journal=J Epidemiol |volume=23 |issue=4 |pages=288–94 |year=2013 |pmid=23831693 |pmc=3709546 |doi= |url=}}</ref><ref name="pmid23108319">{{cite journal |vauthors=Yeung AK, Di Lorenzo C |title=Primary gastrointestinal motility disorders in childhood |journal=Minerva Pediatr. |volume=64 |issue=6 |pages=567–84 |year=2012 |pmid=23108319 |doi= |url=}}</ref> | ||
**CIPO is a more severe form of ileus resulting from disturbances in autonomic nervous system and smooth muscle cell function. | |||
**the cause of CIPO can be idiopathic, sporadic, or secondary to metabolic/endocrinological, neurological, and paraneoplastic disorders. | |||
**CIPO is often due to dysfunction in the innervation of smooth muscle by the interstitial cells of Cajal resulting in partial or complete intestinal aperistalsis. However, any condition affecting the autonomic nervous system (both intrinsic or extrinsic), smooth muscle cells and neuromuscular junction may lead to development of CIPO | |||
*The other common cause of ileus are the drugs that affect intestinal motility and alteration in electrolyte levels. | *The other common cause of ileus are the drugs that affect intestinal motility and alteration in electrolyte levels. | ||
**Drugs affecting intestinal motility primarily includes antimotility agents and other drugs such as opiates, vincristine. | **Drugs affecting intestinal motility primarily includes antimotility agents and other drugs such as opiates, vincristine. | ||
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overview
Pathophysiology
Ileus is defined as temporary cessation of intestinal peristalsis in the absence of mechanical obstruction. The pathogenesis of ileus is multifactorial. Intestinal peristalsis is primarily regulated by autonomic and central nervous system. However, certain medications and metabolism products may also alter the normal intestinal equilibrium leading to temporary dysfunction in intestinal movements. With increasing time, intestinal aperistalsis results in accumulation of air and fluid in the bowel lumen.
- The most common cause of ileus is abdominal surgery.[1][2][3]
- The risk of postoperative ileus depends upon the type of surgery; with the highest risk associated with colorectal surgery. In fact, post-operative ileus is so common that it is sometimes regarded as a normal sequelae of surgery. Post-operative ileus lasting longer than 3 days is termed as paralytic ileus.
- When a patient is undergoing a surgical procedure, it often puts the body under significant stress. This stress may lead to release of inflammatory and neuroendocrine mediators (such as nitric oxide, VIP and substance P) that may result in the development of ileus.
- Stress inducing conditions may lead to increased recruitment of dendritic cells, natural killer cells, monocytes, T cells, macrophages, and mast cells. The macrophages and mast cells are considered the key cells in initiating the inflammatory process and release of chemical mediators.
- Recent research has shown that inhibition of inflammatory mediators (such as nitric oxide & VIP) may lead to improved gastrointestinal peristalsis and function.
- CIPO is a more severe form of ileus resulting from disturbances in autonomic nervous system and smooth muscle cell function.
- the cause of CIPO can be idiopathic, sporadic, or secondary to metabolic/endocrinological, neurological, and paraneoplastic disorders.
- CIPO is often due to dysfunction in the innervation of smooth muscle by the interstitial cells of Cajal resulting in partial or complete intestinal aperistalsis. However, any condition affecting the autonomic nervous system (both intrinsic or extrinsic), smooth muscle cells and neuromuscular junction may lead to development of CIPO
- The other common cause of ileus are the drugs that affect intestinal motility and alteration in electrolyte levels.
- Drugs affecting intestinal motility primarily includes antimotility agents and other drugs such as opiates, vincristine.
- Abdominal conditions such as gastroenteritis and peritonitis may also affect the intestinal motility leading to ileus.
- Electrolyte abnormalities such as hypokalemia, hypercalcemia, hypermagnesemia, acidosis
- Inhibitory neural reflexes
- Inflammation: Ileus may increase adhesion formation, because intestinal segments have more prolonged contact, allowing fibrous adhesions to form, and intestinal distention causes serosal injury and ischemia. Intestinal distention has been shown to cause adhesions in foals. [7] In a recent survey of ACVS diplomates on drugs to prevent ileus and therefore prevent adhesions. The drug used in this survey was lidocaine, erythromycin, and cisapride. [8] Some respondents also mentioned the importance of walking horses postoperatively to stimulate motility. Repeat celiotomy to decompress chronically distended small intestine and remove fibrinous adhesions is also a useful method of treating ileus and reducing adhesions, and it has been associated with a good outcome. [9][10]
- Neurohumoral peptides
References
- ↑ Kalff JC, Schraut WH, Simmons RL, Bauer AJ (1998). "Surgical manipulation of the gut elicits an intestinal muscularis inflammatory response resulting in postsurgical ileus". Ann. Surg. 228 (5): 652–63. PMC 1191570. PMID 9833803.
- ↑ Espat NJ, Cheng G, Kelley MC, Vogel SB, Sninsky CA, Hocking MP (1995). "Vasoactive intestinal peptide and substance P receptor antagonists improve postoperative ileus". J. Surg. Res. 58 (6): 719–23. doi:10.1006/jsre.1995.1113. PMID 7540700.
- ↑ Kalff JC, Schraut WH, Billiar TR, Simmons RL, Bauer AJ (2000). "Role of inducible nitric oxide synthase in postoperative intestinal smooth muscle dysfunction in rodents". Gastroenterology. 118 (2): 316–27. PMID 10648460.
- ↑ Di Nardo, G.; Di Lorenzo, C.; Lauro, A.; Stanghellini, V.; Thapar, N.; Karunaratne, T. B.; Volta, U.; De Giorgio, R. (2017). "Chronic intestinal pseudo-obstruction in children and adults: diagnosis and therapeutic options". Neurogastroenterology & Motility. 29 (1): e12945. doi:10.1111/nmo.12945. ISSN 1350-1925.
- ↑ Iida H, Ohkubo H, Inamori M, Nakajima A, Sato H (2013). "Epidemiology and clinical experience of chronic intestinal pseudo-obstruction in Japan: a nationwide epidemiologic survey". J Epidemiol. 23 (4): 288–94. PMC 3709546. PMID 23831693.
- ↑ Yeung AK, Di Lorenzo C (2012). "Primary gastrointestinal motility disorders in childhood". Minerva Pediatr. 64 (6): 567–84. PMID 23108319.
- ↑ Lundin C, Sullins KE, White NA and al. Induction of peritoneal adhesions with small intestinal ischaemia and distention in the foal. Equine Vet J 21: 451, 1989
- ↑ Van Hoogmoed and Snyder
- ↑ Vachon AM, Fisher AT. Small intestinal herniation through the epiploic foramen: 53 cases (1987-1993). Equine Vet J 27: 373, 1995
- ↑ Southwood LL, Baxter GM. Current concepts in management of abdominal adhesions. Vet Clin North Am Eq Prac 13:2 415 1997